101 - Adult Sepsis In A Pediatric Hospital; A Look At How We Are Doing

Poster Number: 101
Publication Number: 101.307

Alex Kingsbury, University of Tennessee Health Science Center College of Medicine, Memphis, TN, United States; Bindiya Bagga, University of Tennessee Health Science Center College of Medicine, Memphis, TN, United States; Danielle Severns, University of Tennessee Health Science Center College of Medicine, Memphis, TN, United States; Alina N. West, University of Tennessee Health Science Center College of Medicine, Memphis, TN, United States; Kim Giles, Le Bonheur Children's Hospital, Memphis, TN, United States; Samir H. Shah, Univesty of Tennessee Health Sciences Center, Memphis, TN, United States

Background: As our efforts to provide comprehensive medical homes for children affected with a multitude of chronic medical problems progress, so do the number of patients surviving into adulthood with these chronic conditions. As the number of the inpatient admissions increases, the volume and severity of illness of in pediatric intensive care units (PICU) does so as well. There exists little, if any, insight in the literature regarding the outcomes of adult patients presenting to pediatric hospitals with severe sepsis.

Objective: The purpose of this study is to provide a descriptive analysis of adult patients presenting to a pediatric hospital with severe sepsis and adherence to current Centers for Medicare Services (CMS) Core Measures (SEP-1).

Design/Methods: This study is a retrospective cohort analysis utilizing patient records identified by an existing internal sepsis alert system between the years of 2017-2021. Inclusion criteria included patients aged 19-65 years admitted to a pediatric children’s hospital and identified as meeting severe sepsis criteria via alert system. Primary outcomes included a descriptive analysis of patients, including demographics, co-morbidities, and morbidity at discharge; and adherence to CMS SEP-1 measures. At the time of this analysis, patients identified from 2017 to 2018 have been included.

Results: Of sixty-eight patients enrolled, 63.2% were female with a mean age of 22.7 years, 52% and 8.8% were enrolled on Medicaid and Medicare, respectively, and 62% were Caucasian. At least one chronic medical problem, characterized by system, was present in 98% of patients, two in 72% and three systems in 57%. Neurologic (58%) followed by Cardiovascular (58%) were the most common. Length of stay was a mean time of 12.47 days. 72.1% of patients were cared for in the ICU during their hospitalization. At discharge, 89.7% had no new morbidities from arrival, with the most common being pressure ulcers (4.4%). SEP-1 measures were met in patients presenting with severe sepsis on arrival in 36% instances and during admission in 2% of instances. No measures were met for septic shock.Conclusion(s): Severe Sepsis remains a significant contributing factor to morbidity and mortality worldwide. As we see an increase in patients aged > 18 years of age admitted to pediatric hospitals for specialty services, we must more diligently examine our efforts towards identifying severe sepsis, its’ mimics, and management. While ongoing, initial review demonstrates a lack of appropriateness and timeliness of our response to severe sepsis for adults being care for in a pediatric setting.